Remote Part-Time RN: Utilization Review & Care Management

Intermountain Healthcare Inc.; Annapolis (MD); Remote; USD 57,000 - 86,000; Part time

Benefits offered by this job

Generous benefits package

PEAK tuition coverage program

Remote work option

Job summary

Intermountain Health is hiring for an RN Utilization Review Care Management I to perform screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role requires collaboration with patients, families, providers, and insurers to ensure compliant utilization review services.

We offer flexible work options where approved. The position includes enterprise-wide shift coverage, with average 2 days per week and 2 weekends per 8-week schedule, plus holiday coverage.

Qualifications

• Current RN license in state of practice with compact licensure within service area.
• BSN within four years of hire/promotion.
• Experience in care management/navigation or related field including Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator role.
• Clinical nursing experience in an inpatient hospital setting and familiarity with hospital terminology and processes.
• Knowledge of disease management, treatment, length of stay, barriers to delivery of care.

Responsibilities

• Review and investigate medical records to verify medical necessity and utilization.
• Apply evidence-based guidelines and policies for prior authorization and post-service reviews.
• Follow regulatory guidelines and ensure timely communication with members and providers.
• Engage with providers to ensure safe and efficient care and appropriate care settings.
• Collaborate with physicians, staff, members and families to expedite authorizations and direct to appropriate care.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

Job description

Intermountain Health is hiring for an RN Utilization Review Care Management I to perform screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role requires collaboration with patients, families, providers, and insurers to ensure compliant utilization review services.

We offer flexible work options where approved. The position includes enterprise-wide shift coverage, with average 2 days per week and 2 weekends per 8-week schedule, plus holiday coverage.